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Needham, Gail T g-,/s NEWYORK STATE DEPARTMENT OFHEALTH Burial - Transit Permit Bureau of Vital Records Name First Middle Last Sex Gail T.Needham Female tp"; *' Date of Death Age 1 If Veteran of U.S.Armed Forces, 10/24/2020 86 Years War or Dates , Place of Death Hospital,Institution or WCity,Town or Village Glens Falls Street Address The Pines At Glens Falls Center For Nursing&Rehabilitation Q Manner of Death © Natural Cause ❑Accident ❑Homicide ❑Suicide ❑Undetermined ❑Pending WCircumstances Investigation ILIQ Medical Certifier Name Title Jennifer Donovan DO Address • 170 Warren St,Glens Falls,New York 12801 Death Certificate Filed District Number Register Number City,Town or Village Glens Falls 5601 487 `., ❑Burial Date Cemetery,Crematory or Facility Name 10/28/2020 Pine View Crematory • ❑Entombment Address '. a Cremation Queensbury Town,New York ❑Donation Z Date Place Removed 0 ❑Removal and/or and/or Held N Hold Address 0 d Date Point of N ❑Transportation Q by Common Shipment Carrier Destination ❑Disinterment Date Cemetery Address ❑Reinterment Date Cemetery Address Permit Issued to Registration Number Name of Funeral Home Alexander Baker Funeral Home 00037 • Address t 3809 Main St,Warrensburg,New York 12885 Name of Funeral Firm Making Disposition or to Whom j- Remains are Shipped,If Other than Above N Address CC t11 O.. Permission is hereby granted to dispose of the human remains described above as indicated. Date Issued 10/27/2020 Registrar of Vital Statistics W96ertAntfrew Curtis(E(ectronicatTy Signed) i, (signature) District Number 5601 Place Glens Falls, New York I• certify that the remains of the decedent identified above were disposed of in accordance with this permit on: I— W. Date of Disposition /0�21�76 Place of Disposition ) la—t— W (address) U) CC (section) ait) (lot number (grave number) UZ1 (f �0` Name of Sexton or Person in Chafe of Premises U,,,�1t ease pry?/ Signature L^!' Title li tiV►Z DOH-1555(o7/18)p 1 of 2 Public Health Law Sec. 4145(2b) 1414 9 Receipt Human remains of k delivered on , 20 F 7 Pine View Cemetery Representing the funeral home named on burial permit Official Funeral Directors Reg.or License#fr" =